Provider Demographics
NPI:1821003260
Name:PROGRESSIVE DENTAL, PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:SONNY
Authorized Official - Last Name:SPERA
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-722-5464
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13748-0198
Mailing Address - Country:US
Mailing Address - Phone:607-722-5464
Mailing Address - Fax:607-754-9526
Practice Address - Street 1:703 CONKLIN RD
Practice Address - Street 2:
Practice Address - City:CONKLIN
Practice Address - State:NY
Practice Address - Zip Code:13748-0198
Practice Address - Country:US
Practice Address - Phone:607-722-5464
Practice Address - Fax:607-754-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty